Low-profile intercranial device

ABSTRACT

Provided is a functional, low-profile intercranial device (LID). The LID includes a base portion; at least one cavity associated with the base portion and configured to accept at least one functional component; and at least one conduit having a first end in communication with the at least one cavity. The at least one functional component includes a medicinal, electronic, or optic therapeutic. The at least one conduit is configured to accept the medicinal therapeutic and a second end configured to dispense the therapeutic.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. application Ser. No.15/756,010 filed Feb. 27, 2018, now allowed, which is a national phaseapplication of PCT/US2016/030447 filed May 2, 2016, which claimspriority to U.S. Provisional Patent Application Ser. No. 62/214,702entitled “Functional Custom Craniofacial Implants” filed on Sep. 4,2015, the entirety of all of which are incorporated by reference herein.

FIELD OF THE INVENTION

This invention relates generally to the field of surgery, particularlycranioplasty, craniomaxillofacial surgery and neurosurgery, andspecifically to the field of customized craniofacial implants.

BACKGROUND OF THE INVENTION

Systemic delivery of medication to the brain is hindered by theblood-brain barrier's (BBB) highly selective permeability, which allowsthe highly-specified passage of only certain materials from capillaryblood into the brain's extracellular fluid. In fact, recent reportsstate that over 60% of all pharmaceutical laboratories specific toneurologic medicine development are shutting down due to thecomplicated, gridlock barriers preventing successful delivery ofblood-based medicines into the brain. As such, much work has beenfocused on engineering medicinal compositions to be small andhydrophobic enough to diffuse through the endothelial cells that make upthe complex BBB. However, this has been suboptimal since many of themedicinally-advantageous compositions are simply too large orhydrophilic and are cannot be engineered for such direct delivery to thebrain. As such, an improved anatomical location, such as improvedposition of patient-specific, pre-fabricated devices within the cranialbone space and strategy for enhanced delivery of battery-poweredplatforms capable of local neurological medicine delivery would be awelcome addition to the art.

Meanwhile, during cranioplasty procedures, diseased or damaged portionsof the skull (craniectomy defects) are safely removed and replaced,while the brain is exposed underneath without injury. Followingresection of diseased cranial bone, such craniectomy defects are oftenreconstructed with custom craniofacial implants (CCIs)—as opposed tousing generic, “off-the-shelf” materials. Historically, however,cranioplasty patients requesting CCI-based reconstruction for an idealappearance have been limited to “second-stage” operations in instancesof pre-existing skull defects so that the exact fit and design could beobtained. However, recent modifications to the approach have allowed afew isolated surgical teams to perform “single-stage cranioplasties”—bywhich a clinician, such as a surgeon, manually reshapes/resizes apreviously-ordered, custom implant (with oversized dimensions) to fitperfectly into the skull defect—as opposed to using “off-the shelf”materials. Either way, for single-stage methods involving skull tumorsor second-stage cranioplasties for pre-defined skull defects, the adventof computer-aided design/manufacturing (CAD/CAM), has provided surgeonsalike with perfectly-shaped CCIs designed and manufactured based in parton fine cut preoperative computed tomography (CT) scans andthree-dimensional reconstruction (+/−stereolithographic models).

In fact, recent reports suggest that the use of CCIs can improvecosmesis, decrease operative times, prevent scalp-related woundcomplications, and enhance patient satisfaction—and therefore, theyserve as an ideal medium for reconstructing neurosurgery patients. Forexample, International Patent Application No. PCT/US2014/067656, filedon Nov. 26, 2014 and entitled “Computer-Assisted CraniomaxillofacialSurgery,” describes a recently-developed surgical workstation's with thenovel ability to provide intraoperative visual guidance related toplanned-versus-actual position of CCI (on intraoperative visualmonitors)—following placement of the CCI within the three-dimensionalcraniofacial defect (in relation to virtual plan)—which ultimately addseven greater precision and simplicity to this complex operation.Similarly, all CCIs up until now have been used to replace abnormal bonehaving some form of disease, either of benign or malignant etiology.These customized skull implants may be termed “static CCIs”(SCCIs)—mainly because their main constant (i.e. unchanged purpose withrespect to time) purpose encompasses strictly two benefits followingplacement—“brain protection” and “enhanced appearance”.

Meanwhile, there are other “off the shelf” neurological implants thathave functionality, such as delivering electrical impulses, but aren'tcustomizable or designed to protect the brain. Most of these so calledFunctional Neurological implants (FNI) fall into two categories: DeepBrain Stimulators (DBS) and Cortical Brain Stimulators (CBS). Modern dayneurologic devices are confronted and challenged with high extrusion andinfection risk (i.e. current flaws in modern day devices leads to highincidence of extrusion through skin thereby requiring prematureexplantation) approaching 50%. Similarly, battery-powered, low-profiledevices for intercranial placement currently do not exist on the market.As such, the field of neurosurgery has been hampered and limited in manyareas including examples like battery-powered neuromodulation/corticalstimulation and delivery of neurological medicines.

But with increasing experience and now surgical complication ratesexceedingly low, for the CCIs can also be modified in real-time forscenarios where more or less skull bone is removed and the skull defectdimensions do NOT match up perfectly to the pre-fabricated CCI (versusan originally envisioned, for example, as designed in a planningstage)—including such associated methods of making the CCIs aredescribed in co-pending U.S. Provisional Patent Application No.62/155,311, filed on Apr. 30, 2015 and entitled “A Cutting Machine ForResizing Raw Implants During Surgery”, U.S. Provisional PatentApplication No. 62/117,782, filed on Feb. 18, 2015 and entitled“Computer-Assisted Cranioplasty”; and International Patent ApplicationNo. PCT/US14/67656, filed on Nov. 26, 2014 and entitled“Computer-Assisted Craniomaxillofacial Surgery”, the disclosures ofwhich are hereby incorporated by reference herein in their entireties.

Due to the recent reductions for time needed to design, fabricate andimplant CCIs, more cranioplasty procedures with alloplastic implants arebeing performed around the world than ever before. Accordingly, theserecent developments in CCI sterility, shape design, and streamlineproduction—together provide an opportunity that extends CCI-basedcranioplasty beyond only patients who require replacement ofpre-existing craniectomy defects. Therefore, what is needed in the art,are new pre-fabricated, customized, patient-specific implantable deviceswith low-profiles (i.e. to avoid scalp-related complications and highextrusion risk leading to premature explantation). What is also neededin the art are corresponding methods of making and implanting suchimplant devices, including methods using computer-assisted surgicalprocedures, such as computer-assisted cranioplasty. Such improvementswould exploit the benefits of direct access to the brain and idealanatomical location/proximity provided by these novel CCIs placeddirectly on top and just a few millimeters away from the brain todeliver life-changing interventions provide an unprecedented method todeliver locally, for example, Neurologic Deep Brain stimulations, orneurologic medicines, that are otherwise prevented from diffusingthrough the blood-brain barrier via common delivery methods (i.e. oral,intravenous) and battery-powered functions via various encasedcomponents including neuromodulation devices, imaging devices, radiationtherapy devices, and remote sensing/monitoring devices.

SUMMARY

In an embodiment, there is a functional, low-profile intercranial device(LID). The LID includes a base portion; at least one cavity associatedwith the base portion and configured to accept at least one functionalcomponent; and at least one conduit having a first end in communicationwith the at least one cavity. The functional component includes amedicinal therapeutic. The at least one conduit is configured to acceptthe medicinal therapeutic and a second end configured to dispense thetherapeutic.

In another embodiment, the LID includes a base portion; and at least onecavity associated with the base portion and configured to accept atleast one functional component. The functional includes a physiologicalcondition intervention system.

In another embodiment, the LID includes a base portion; at least onecavity associated with the base portion and configured to accept atleast one functional component; and a controller. The at least onecavity includes a first cavity and a second cavity, and the functionalcomponent includes a first functional component and a second functionalcomponent. The first functional component includes a medicinaltherapeutic; at least one conduit that includes a first end incommunication with the first cavity and configured to accept themedicinal therapeutic, and a second end configured to dispense thetherapeutic. The controller is configured to initiate or terminatedispensing of the medicinal therapeutic. The second functional componentcomprises a physiological condition intervention system and at least oneconduit configured to transmit a signal between the second functionalcomponent and a patient. The physiological condition intervention systemincludes: a power source; and a sensor powered by the power source andconfigured to sense a physiological condition. The controller is furtherconfigured to activate the power source, the sensor or both.

In another embodiment, there is a surgical method that includesreplacing or removing an anatomical portion of a being and attaching aLID to the being. The LID comprises a base portion and at least onecavity associated with the base portion and configured to accept atleast one functional component.

In another embodiment, there is a surgical method that includes removingan implant that is attached to a being; and attaching a low-profileintercranial device (LID) at a location on the being where the implantwas located. The LID comprises a base portion and at least one cavityassociated with the base portion and configured to accept at least onefunctional component.

An advantage of at least one embodiment provides a low-profileintercranial device (LID) that can replace either skull defects of anysize following pathology-based resection and/or normal bone removal forbrain-based intervention. In at least one embodiment, a LID includes oneor more of a functional component for delivering radiation therapyand/or neurological medicines. In at least one embodiment, a LIDincludes one or more functional component for remote sensor-monitoringfor abnormal levels of intracranial pressure (ICP) or brain activity(i.e. seizures), such as an electrical array for motor/vision cortexcontrol, battery-based stimulation hardware for epilepsy management(grids/batteries/wires), low-profile remote imaging devices (e.g.,optical coherence tomography (OCT), duplex ultrasound). Such functionalcomponents may or may not be directly connected to the brain viawiring/electrodes, an intra-ventricular catheter (IVC) for ventricledelivery, intra-neural wiring (for parenchymal delivery), and/or otherconduit for blood vessels (for intravenous delivery). In at least oneembodiment, a LID includes one or more of a functional component thathas the ability to deliver and/or sense electrical impulses, take remoteimages/photographs of anatomical features, deliver neurologic medicinesinto the brain's blood vessels, ventricles of the brain, and/or directlyinto cerebral fluids. Accordingly, by at least one embodiment describedherein, there is provided an intercranial device and/or method forcircumventing the ever-challenging BBB, which in turn, can drasticallyincrease efficacy for a variety of neurological diseases and at the sametime reduce current toxic doses with high-frequency, adverse reactionprofiles. Thus, at least some embodiments described herein provide forthe removal of either diseased skull bone and/or normal skull bone—forpatients in need of future neurological intervention (i.e. medicinedelivery, remote monitoring, radiation therapy, neuromodultaion,etc.)—as a method to deliver medicines and/or electricity-basedintervention in a safe way locally (using the valuable dead space withinthe standard CCI) and in turn eradicating the obstacles of the BBB andaccompanying high extrusion rates of current day extracranial deviceseroding through the scalp requiring premature removal. Such embodimentscan be valuable for patients with brain-related disease, and thusrequire removal of normal healthy skull bone in exchange for enhancedtreatment with minimal complication. Besides neurological medicines,other advantages of the embodiments provide a novel method and deliverysystem for local application of radiation therapy (via radioactive seedshoused within the implant), remote neuro-monitoing (i.e., opticalcoherence tomography), remote neuro-imaging (i.e. electroencephalogram(EEG)), and/or novel neuromodulation in streamlined fashion withencased, low-profile batteries and wiring all housed within the single,pre-fabricated implant.

Additional advantages of the embodiments will be set forth in part inthe description which follows, and in part will be understood from thedescription, or may be learned by practice of the invention. Theadvantages will be realized and attained by means of the elements andcombinations particularly pointed out in the appended claims.

It is to be understood that both the foregoing general description andthe following detailed description are exemplary and explanatory onlyand are not restrictive of the invention, as claimed.

The accompanying drawings, which are incorporated in and constitute apart of this specification, illustrate embodiments of the invention andtogether with the description, serve to explain the principles of theinvention.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 illustrates a resulting “CCI-based cranioplasty reconstruction”with rigid fixation

FIG. 2 is a low-profile intercranial device (LID) of an embodiment.

FIG. 3A is a close up view of functional component of the LID of FIG. 2according to an embodiment.

FIG. 3B illustrates a syringe delivering medication to a functionalcomponent of an embodiment having a porous body or port for acceptingthe syringe needle.

FIG. 3C illustrates a configuration for a multiplicity of functionalcomponents that may be interconnected to form a 7-cell cluster and/orencased battery unit.

FIGS. 4A-4B illustrate a method of attaching a LID, such as the implantof FIG. 2. FIG. 4A shows a left-sided, posterior, full-thickness skullresection outlined by a cut region and the low-profile intercranialdevice (LID) of FIG. 2 being inserted into the resected portion of theskull.

FIG. 4B shows the resulting implantation of the low-profile intercranialdevice (LID) following FIG. 4B.

DESCRIPTION OF THE EMBODIMENTS

Reference will now be made in detail to the present embodiments,examples of which are illustrated in the accompanying drawings. Whereverpossible, the same reference numbers will be used throughout thedrawings to refer to the same or like parts.

Notwithstanding that the numerical ranges and parameters setting forththe broad scope of the invention are approximations, the numericalvalues set forth in the specific examples are reported as precisely aspossible. Any numerical value, however, inherently contains certainerrors necessarily resulting from the standard deviation found in theirrespective testing measurements. Moreover, all ranges disclosed hereinare to be understood to encompass any and all sub-ranges subsumedtherein. For example, a range of “less than 10” can include any and allsub-ranges between (and including) the minimum value of zero and themaximum value of 10, that is, any and all sub-ranges having a minimumvalue of equal to or greater than zero and a maximum value of equal toor less than 10, e.g., 1 to 5. In certain cases, the numerical values asstated for the parameter can take on negative values. In this case, theexample value of range stated as “less that 10” can assume negativevalues, e.g. −1, −2, −3, −10, −20, −30, etc.

The following embodiments are described for illustrative purposes onlywith reference to the figures. Those of skill in the art will appreciatethat the following description is exemplary in nature, and that variousmodifications to the parameters set forth herein could be made withoutdeparting from the scope of the present invention. It is intended thatthe specification and examples be considered as examples only. Thevarious embodiments are not necessarily mutually exclusive, as someembodiments can be combined with one or more other embodiments to formnew embodiments.

In CCI-based cranioplasty reconstruction, surgeons are rebuilding orreconstructing portions of the craniomaxillofacial skeleton to correctpre-existing deformities (e.g., following trauma decompression) and/ordefects created by various etiologies such as tumor extirpation ortrauma. The defects of the skull and/or facial bones, following bonyresection are all concerning to a patient desiring completereconstruction and visual harmony consistent with his/her pre-operativeappearance. As such, this novel method and delivery system will bevaluable to both instances of the missing cranium and/or facial bones.This could be valuable for those, for example, with trigeminalneurolagia requiring cheek bone resection and LID placement for localdelivery of pain medicines to help control debilitating chronicdisfiguring pain with all battery-powered components confined only towithin the space of the missing bone.

Preoperative imaging such as CT or MRI may be used to identify thepatient's cranial bone anatomy—which would make it quite feasible todesign each LID in patient-specific fashion (as is done currently)—so asto address each patient's clinical care algorithm—both from a skull boneperspective and form an underlying regional brain pathology perspective.CCI-based surgery is currently planned using virtual pre-operativeimaging to help identify an area of interest (e.g., a tumor) of theanatomy requiring reconstruction. For “single-stage cranioplasty”involved skull pathology requiring resection, bone cuts areplanned/created virtually pre-operatively and a custom implant isdesigned, pre-fabricated, molded, and shipped to the surgeon to help fitinto the resected region. The surgeon then attaches the CCI into theresected area using standard plates and screws. Computer-assistedguidance and custom implant position confirmation allows the surgeon tostreamline this complicated process via intraoperative navigationalguidance, for example, as described in International Patent ApplicationNo. PCT/US14/67656, filed on Nov. 26, 2014 entitled “Computer-AssistedCraniomaxillofacial Surgery”. The result shown in FIG. 1 is an implant110 that has an exact fit and is absent of gaps along the periphery 11of the “implant-cranial bone interface” of the patient's skull 100.

The thickness of the CCIs can be preselected and in many instances CCIshave a thickness of around 4-12 millimeters (areas of strategic bulkingfor concomitant temporal hollowing correction allow for extra implantthickness and in turn increased space for LID utilization).Additionally, as related to their ideal proximity to the brain, CCIs maybe imparted with functional capabilities as described for the novelmethods and devices described herein. Accordingly, described herein areimplants that are configured with functionality beyond structuralsupport and sit comfortably within the boundaries of the anatomicalskull defect. In some embodiments, such implants may be referred to aslow-profile intercranial devices (LIDs).

As used herein, the term “functional component” or “functional cells”means any therapeutic hardware or compositions including, but notlimited to, medicines to treat any patient-specific illness, orelectronic, mechanical, imaging modality and/or electro-mechanicaldevice to remotely monitor (e.g., via Wi-Fi connectivity) or interveneany specific neurologic illness, including imaging, monitoring,electrostimulation, radiation therapy, polarized light/laser neuronalmodulation devices. The term “functional” denotes the fact that theseCCIs are unlike current custom cranial implants, in that they have thecapability to provide an additional purpose(s) or function other than assimply serving as a safe custom-shaped skull replacement via, forexample, local drug delivery, or monitoring, such as brain monitoring orlocal electric stimulation—versus the current static CCI (SCCI), whichis “static” in form and serves only to replace missing bone and providecerebral protection from injury with ideal form and appearancepost-reconstruction.

For example, LIDs may include one or more types of devices (i.e.,functional component/cells) for delivery of local medicines, one or moretypes of valuable neurologic hardware like imaging modalities capable ofproviding real-time neuroimaging (e.g., ultrasound, optical coherencetomography, etc.), intracranial pressure (ICP) monitors with remotecapabilities, small implanted radioactive seeds capable of long-term,chronic delivery of radiation to prevent local tumor recurrence, and/orfunctional wiring/battery/power source for deep brain stimulation andtwo-way feedback. In some embodiments, imaging modalities, such asoptical coherence tomography (OCT), and/or high definition duplexultrasound (U/S), may be stored and fossilized within the device. Anyand all light/laser beams emitting from or transmitted to functionalcomponents in the device are unhindered. Such imaging modalities canprovide remote imaging to both the patient and healthcare provider inareas of various brain pathologies like tumor growth, brain swelling, orstroke-like bleeding. In some embodiments, remote EEG and/or ICPpressure sensor hardware may be impregnated within the LID so that EEGtracings and/or intracranial pressure readings can be obtained remotelyat any time, thereby alleviating any form of hospital admission orgeographic constraints challenging optimal neurological treatment. Insome embodiments, continuous EEG and intracranial pressures may bestored either locally for later access or accessed in real-timetransmission, for example, via remote access through a communicationslink such as a wireless e.g., Wi-Fi connection by a remote server. Assuch, trends in patient health (e.g., EEG tracings, ICP readings, bloodflow to damaged brain, etc.) may be monitored and more efficientlyassessed by a healthcare team—therefore drastically reducing thefinancial burden of re-admitting these complex patients to hospitals.For example, in some embodiments, functional wires, pressure sensors,radioactive seeds, and/or low profile batteries may be incorporated inthe LID as part of an on-board, “anatomically-shaped” skull-basedcomputer, capable of controlling a built-in, remote-controlled,electronic monitoring system for novel assistance with electrophysiologymeasurements initiated via internet communication, such as through asecure Wi-Fi connection, between a remote computer and the functionalcomponent (e.g., on-board computer) of the LID. In another example, oneof the functional components incorporated with the LID can comprise anon-board, embedded console connected to an electrode array with attachedsilicon needles and which may be disposed within the LID to help recordelectrical impulses of neurons inside the brain and/or provide stimulusto help bypass spinal cord paralysis and/or help to prevent Alzheimer'sdisease.

Additionally, functional components of the LIDs described herein may beconfigured with wireless/internet connectivity so as to be activatedremotely to (by either healthcare provider, patient, orfamily/friend/caretaker), for example, release patient-specificelectrical stimulation (e.g., electrical cortical brain stimulation),neuroimaging of underlying brain, biofeedback, radiation therapy, and/ormedicines stored within the implant (placed at time of LID fabrication)and then delivered locally into or onto the brain in an unprecedentedfashion to circumvent the BBB and/or to provide real-time, essentialbrain monitoring or radiation therapy of patients to drive futurecare—such as instances of brain tumor recurrence and increased CNSseizure activity, or any other visual brain pathology developments (i.e.Alzheimer's, Parkinson's, etc).

The concept of using LIDs (as opposed to “static” conventional CCIs),for all scenarios including “single-stage cranioplasty” (i.e. truedefect size unknown), “second-stage cranioplasty” (i.e. true defect sizeis known in advance), or even for patients in need of local medicinal orradiation delivery for brain pathology—is exciting due to their manypotential functions following placement and holds major potential fordisease treatments currently hindered by scalp-related radiationproblems and/or the BBB—including Parkinson's, Alzheimer's, braintumors, and epilepsy. Accordingly, in an embodiment shown in FIG. 2 is alow-profile intercranial device (LID) 300 that comprises a base portion310 (e.g., a housing) at least one cavity 323 associated with the baseportion, and at least one conduit 330. The cavity 323 is configured toaccept at least one functional component 322. In an embodiment, theconduit 330 has a first end in communication with the at least onecavity (not visible) and a second end. In an embodiment, the first endof the conduit 330 is in communication with the at least one functionalcomponent. In an embodiment, at least a portion of the at leastfunctional component may be encased in the base portion.

In an embodiment, the functional component 322 comprises a medicinaltherapeutic and the at least one conduit comprises a first end incommunication with the at least one cavity and configured to accept themedicinal therapeutic and a second end configured to dispense thetherapeutic to a patient. The conduit 330 can deliver medicinaltherapeutic to the brain, for example, a diseased portion of brainparenchyma, a dead-space cavity following brain tumor resection, a bloodvessel, neuron or ventricle. The at least one conduit can comprisepolymer tubing. One example of a conduit is a catheter.

In an embodiment, the functional component comprises a physiologicalcondition intervention system and the at least one conduit is configuredto transmit a signal between the functional component and a patient. Forexample, the signal can be a chemical signal, an electronic signal, amagnetic signal or an optical signal. The functional component may beselected based on patient-specific pathology requiring treatment.

The functional component may, therefore, be disposed on a surface of ordisposed within base portion 310. For example, the functional componentmay be disposed in a preformed one of cavity 323, which may be formed asfully or partially enclosed void-space portions of the implant, such ascompartments), may be hermetically sealed within the implant, or may beincorporated in situ such as while forming the implant around it (e.g.,during deposition of the implant material on or around the functionalcomponent 322). In an embodiment, the functional component is detachablyconnected to the base portion, for example, to replace the functionalcomponent with a functional component of the same type or a differentone of a functional component, or to service the functional component.

The device 300 may be a custom, three-dimensional cranial orcraniofacial implant made of either alloplastic materials or biologic,tissue-engineered cells of a being, such as a recipient being on whomthe surgical procedure is performed. For example, base portion 310 maycomprise a polymer, metal, bioengineered material, or combinationsthereof, including but not limited to titanium mesh, poroushydroxyapatite (HA), polymethylmethacrylate (PMMA), polyether etherketone (PEEK), tissue-bioengineered construct, man-made alloplasticmaterial, a tissue engineered construct porous polyethylene (Medpor)and/or combinations thereof.

In an embodiment, the base portion may have a geometry thatsubstantially conforms with, for example, a resected portion of thebeing's anatomy. For example, specifications of the base portiongeometry may be provided for fabrication of a patient-specific baseportion. In an example, fabrication of such a patient-specific baseportion may be performed by a third party. In such an example,measurements of an anatomical area of interest are recorded during aplanning stage, and the measurements of the base portion geometry areprovided to a 3^(rd) party for fabrication. Subsequently, the3^(rd)-party-manufactured base portion may be attached to a patient. Insuch a method a clinician may be required to modify the base portion dueto errors, tolerance variations, or changed circumstances such aschanges in the geometry of the anatomical feature of interest since thetime of initial measurements. Fabrication may be performed via anysuitable known methods for forming modifying the base portion materialsdescribed above, for example, subtractive or additive manufacturingprocess. In another example, fabrication of a patient-specific baseportion may be performed in-situ such as during surgical procedure. Insuch a method, a non-customized “blank” sample of base portion material,such as any of the materials described above, may be manipulatedautomatically or manually. Such a base may be formed using additivemanufacturing techniques such as 3D printing or an off-the-shelf “blank”of base portion material may be manipulated manually.

Another example for making a base portion can include acomputer-assisted, surgical method. Here, the base portion may be formedas an implant. The method can include attaching a reference unit thatincludes a first trackable element to a first anatomical feature of abeing's anatomy, detecting a location of at least the first trackableelement with a detector, and accessing a first computer-readablereconstruction of the being's anatomy. The detector may be configured toprovide at least one signal corresponding to a detected location of atleast the first trackable element. The first computer-readable mayinclude a first updatable orientation, wherein the first updatableorientation may be updated in response to the at least one signal. Themethod may further comprise generating a second computer-readablereconstruction of an implant, the second computer-readablereconstruction comprising a second updatable orientation; assessing asize-mismatch between at least one dimension of a portion of the firstcomputer-readable reconstruction corresponding to a selected anatomicalfeature of the being's anatomy and at least one dimension of the secondcomputer-readable reconstruction; and tracing cut lines on the implantbased on the size-mismatch such that an anatomical discrepancy at anarea of removal or reconstruction of the anatomical feature is minimizedat a preselected tolerance. Such a method may further comprise attachinga second trackable element to an implant; detecting a location of thesecond trackable element with the detector, wherein the at least onesignal further corresponds to a detected location of the secondtrackable element; accessing a second computer-readable reconstructionof an implant, the second computer-readable reconstruction comprising asecond updatable orientation, wherein the second updatable orientationis updated in response to the at least one signal; and superimposing thesecond computer-readable reconstruction on the first computer-readablereconstruction.

Another example for making a base portion can include resizing a “blank”during surgery. Here, the base portion may be formed as an implant. Themethod can include detecting a first location of a reference unitcomprising a first trackable element with a detector, the detectorconfigured to provide an at least one signal upon detecting the firsttrackable element of the reference unit, wherein the reference unit isassociated with a location of a reference anatomical feature of abeing's anatomy; accessing a computer-readable reconstruction of thebeing's anatomy, the computer-readable reconstruction of the being'sanatomy comprising a first updatable orientation, wherein the firstupdatable orientation is updated in response to the at least one signal;accessing a computer-readable reconstruction of an implant comprising asecond updatable orientation; detecting a location of a pointer toolcomprising a second trackable element with the detector, the detectorfurther configured to provide an at least one other signal upondetecting the second trackable element of the pointer tool, wherein thepointer tool is associated with a location of an anatomical feature ofinterest; accessing at least one computer-readable reconstruction of atrace, the trace corresponding to a geometry of the anatomical featureof interest based on updated detected locations of the pointer tool; andsuperimposing the at least one updatable, computer-readable trace on thecomputer-readable reconstruction of the implant. The method can furtherinclude displaying the computer-readable reconstruction of the trace,for example, by projecting the computer-readable reconstruction of thetrace onto the implant. The method can further include marking theimplant with a marking tool at points on the implant on which thecomputer-readable reconstruction of the trace is projected. The methodcan further include removing portions of the implant adjacent to animplant surface on which the computer-readable reconstruction of thetrace is projected. Alternatively, an image based on at least onecomputer-readable reconstruction of the being's anatomy can besuperimposed onto an implant, and a clinician may remove portions of theimplant adjacent to the superimposed image so that a base portion havinga geometry that substantially conforms to the being's anatomy is formed.

In another example a method for forming a base portion can includeforming with an autonomous manufacturing device. The method includesaccessing a first computer-readable reconstruction of a being's anatomy;accessing a second computer-readable reconstruction of an implant;accessing a third computer-readable reconstruction comprising the firstcomputer-readable reconstruction superimposed with the second computerreadable reconstruction; generating at least one computer-readable tracefrom a point cloud; and forming an implant with an autonomousmanufacturing device, wherein the autonomous manufacturing device formsthe implant into a shape defined by at least one dimension of thecomputer-readable trace. The method can further include generating aprojected trace from the computer-readable trace, wherein the projectedtrace comprises a 2D or 3D projected trace and projecting the projectedtrace onto the implant.

Depending on the needs of a patient, at least one of functionalcomponent 322 may comprise low-profile, anatomically-shaped batteries,fossilized wiring system, encased imaging modalities, fossilizedradioactive therapy seeds, and/or neurologic medicines stored locallywithin an inner portion of the device 300 (such as prefilled void spacesof the implant) while the structural integrity of the implant itself isnot affected. In an embodiment, the functional component 322 may be avital sign monitor, OCT image monitor, intracranial pressure (ICP)monitor, a remote imaging monitor or combinations thereof. Temperaturecontrol monitors may be included to monitor battery core temperaturesand allow cut off measures in case of an alarm condition for thebatteries being reached. In some embodiments, at least one of functionalcomponent 322 may be an electrical impulse generator, OCT imagerecorder, ICP reader, radioactive seed(s), or medicine dispensing devicepositioned in compartments formed within the confines of the implant.Each such functional component may be configured to deliver atherapeutic by way of a conduit, which may be, for example, a wire orcatheter (i.e. IVC). In other embodiments, at least one of functionalcomponent 322 may be selected from various monitoring devices, forexample, those with ICP or radiographic capabilities (e.g., local OCT orduplex ultrasound of underlying brain to asses for tumor recurrence),and may positioned in the device, such as in a cavity of the devicewhich may be formed as a compartment configured to accept a functionalcomponent.

In an embodiment, at least one of functional component 322 may comprisebiosensors (e.g., one-way or two-way biosensors) that provide real-timebiofeedback and critical imaging of the brain when and if neededpost-operatively via intracranial pressure (ICP) sensors. In addition,at least one of functional component 322 may be configured to provideimmediate, life-saving pathophysiology-specific intervention when and ifnecessary, for example, with a remote control controlled by aphysician/surgeon and/or patient's caretaker (family/friend). At thesame time, the outside dimensions of the custom implant may remain thesame exact size and shape as conventional implants used currently fortime-tested, large-sized cranial or craniofacial reconstruction inpre-existing skeletal defects and connect via remote capabilities likeWi-Fi or Bluetooth—thus avoiding the modern day challenges ofconventional implants that lead to premature removal related to scalpbreakdown, infection and ultimate removal.

The conduit 330 may be in mechanical, electromagnetic, magnetic,radioactive, electronic or fluidic communication with at least a portionof the device 300 on one end and with a patient on the other end. Forexample, the at least one conduit 330 may have a first end incommunication with the at least one cavity, the at least one offunctional component 322, or both, and may have a second end inmechanical, electronic or fluidic communication with the patient, forexample, the patient's neuron, blood vessel and/or ventricle. Theconduit 330 may be a dispensing tube, wire, battery, fiber optic wire,radioactive seed, shunt, pump, vessel or an intraventricular orintravenous catheter (IVC) and may be inserted at the time of LID-basedskull reconstruction. While not limited to any particular embodiment,the conduit 330 can provides for transit of a therapeutic, such aspatient-specific and illness-specific medicine and/or computer-guidedresponsive stimulation from a functional component of the LID to abiological element of a being. For example, electrical impulses(signals), local radiation, and/or medicine may be transported fromfunctional component 322, through the conduit 330, and directly into thebrain cavity (following tumor resection), a neuron, blood vessel, orventricle directly, thereby circumventing, among other things, the bloodbrain barrier. In other words, the device 300 with the conduit 330provides immediate intra-neural or intra-thecal or intra-vasculardelivery through catheters, biosensors and wiring intimately connectedto the device, for example, in the functional component.

In an example, conduit 330 may be a coupling device that includes aninput and an output for directing cerebrospinal fluid (CSF) or bloodthrough preselected chambers of a functional component. Valves may beincorporated in the device 300 or along conduit 330, or within thefunctional component(s) 322 to designate flow direction of the CSF orblood. In an example, the valves may be CSF valves as these have sizesthat are compatible with the LIDs of the embodiment. Exemplary ones ofsuch valves include the Ultra VS, “Flow regulating valve mini” availablefrom Integra NeuroSciences of Plainsboro, N.J. and may be as small as 13mm×3.8 mm×3 mm.

While not limited to any particular medicine or radioactive element orneurostimulation hardware or imaging modality, the functional component322 may comprise anti-brain tumor, anti-seizure, anti-bleeding,anti-Alzheimer's anti-Parkinson, anti-hydrocephalus, and anti-ADHDmedications—all of which is based on the patient's exact needs prior toimplant design and manufacturing. While not limited to any particularmonitoring, the functional component may be configured to provide vitalsign and intracranial pressure (ICP) monitoring and may be able toprovide life-saving, immediate, battlefield-like intervention whenneeded, for example, for members of the military or civilian police. Inan example, at least one of the functional components of a LID couldprovide for intra-thecal delivery of morphine (i.e. pain relief at timeof life-threatening injury) or norepinephrine (i.e. a sympathomimeticstimulant in time of fighting), administered upon an electromagnetic(e.g., Wi-Fi) signal activating a controller that initiates dispensingof such medicinal therapeutic from the functional component, forexample, to those in the battlefield and/or civilian trauma environment(e.g., police, firemen)sustaining life-threatening injuries and/or inextreme pain on the verge of dying or in need of aided energy orstrength at time of warfare.

As shown in FIG. 3A, the functional component 322 may include one ormore ports 327. The one or more ports may provide, for example,electronic access to a central core, such as a controller including, forexample, a processor and memory, and additionally, a wireless module sothat the controller is configured for wireless connectivity, oradditional connection portals. The one or more ports 327 may have auniform size, shape, or both to so that other devices may connect withother ones of the functional components 322 of the LID device Dependingon the need, the at least one port 327 may be configured for use as aninterface for instruments delivering refills of medicines, devices forcharging on-board batteries, devices for uploading software updates toon-board computers, or for engaging with and replacing the functionalcomponent. In an embodiment, the one or more ports 327 may be incommunication with conduit 330 or with one or more ports of another oneof the functional component. The at least one port 327 may be at leastone access port for accessing, for example, a computer or electronics ofthe functional component, or medicinal composition stored in thefunctional component.

The device 300 may include structural internal support features. Forexample, the base portion may include internal supports through aninternal portion of the base, such as pre-made PMMA endo skeletons,titanium endo skeletons, boxes, containers, scaffold, framework,traditional “green bread board” circuits, small pre-made PMMA pillars,titanium rods or rebar, screws, among other structural supportingfeatures. Additionally, the device 300 functional components, which mayinclude a battery-powered platform, can be strategically placed withinthe dead space area to optimize available volume and utilization, and atthe same time, retain strength and protection to the underlying brain.

In an embodiment, the functional component 322 may include a gyroscope(digital or analog) to provide location precision, orientation, etc. Inan embodiment, such location/orientation information can provide fortriangulation for precision civilian care.

The functional component 322 may be configured with wireless (e.g.,Wi-Fi/Bluetooth) and/or internet connectively, for example, Wi-Fi sothat they may be controlled remotely or provide remote monitoring bycollecting data and transmitting the data wirelessly back to thephysician/surgeon/radiologist/hospital as described below. Furthermore,the implant could house a separate computer with various functions forprevention and/or immediate treatment/correction of certainneuropathology. Energy for LID function can be achieved through variousmethods such as perpetual motion used for wrist watches by way ofkinetic energy, or could be simply based on low-profile, long-durationbatteries (i.e. lithium) such as in the case of current cardiacpacemakers. In a future stage of this invention, there may be a role foranatomically-shaped batteries with patient-specific curvatures (i.e.battery shapes custom built for each patient) to better align with thecontours of the skull anteriorly or posteriorly to optimize theimplant's low-profile shape.

The communication between the LID and its patient could be valuable ininstances where symptoms develop—for example Alzheimer's disease orParkinson's tremor or epilepsy with signs of pre-syndrome for impendingdementia, tremor, or seizure. As such, as shown in FIG. 3A, the device300 of the embodiments may include a functional component 322 that hasan on-board functionality 329, such as such as a medicinal therapeutic331, a physiological condition intervention system 333, or both.

In an example, the medicinal therapeutic comprises optogenetic proteins,radiation therapy, chemical therapy, or a combination thereof. Exemplarymedicinal therapeutics comprise one or more therapies selected from thegroup consisting of anti-tumor, anti-seizure, anti-parkinson,anti-hydrocephalus, anti-ADHD, anti-alzheimer's, anti-pain,energy-enhancing, and combinations thereof.

In an embodiment, the physiological condition intervention system 333 isconfigured for computerized monitoring of a physiological condition suchas abhorrent seizure activity, inter-cranial pressure elevation, or bothfor example by monitoring of a diseased portion of brain parenchyma, adead-space cavity following brain tumor resection, a blood vessel, aneuron, a ventricle or combinations thereof. Accordingly, thephysiological condition intervention system 333 may be configured toprovide acute neurological intervention comprising medicinal therapy,electro-stimulation therapy, radiation therapy or a combination thereof,such as to provide neuron modulation via optic sensors. In an example,conduit 330 is in at least one of fluidic, electrical, magnetic, oroptical communication between the physiological condition interventionsystem and a patient. As one example, the computerized monitoringcomprises imaging, such as optical coherence tomography (OCT),intracranial pressure (ICP) monitoring, vital sign monitoring orcombinations thereof. Therefore, the physiological conditionintervention system may include at least one of a vital sign monitor,OCT image monitor, ICP monitor, remote imaging monitor or combinationsthereof. Exemplary physiological condition intervention systems mayinclude an electrical system, remote imaging system, encasedbattery-powered system, radiation system, responsive neurostimulationsystem, neuromodulation system (e.g., battery-powered neuromodulation),drug delivery system, or combinations thereof. Such systems may includea medicine delivery device, an electrical signal delivery device, animage capture device, a radioactive seed device, an energy storagedevice, a computing device, or combinations thereof. In an example, thephysiological condition intervention system comprises at least one of anelectrical energy source, an electrical energy detector, electromagneticenergy source, an electromagnetic energy detector, a therapeuticcomposition source, or combinations thereof. In an embodiment, theelectrical energy source generates an electrical signal. In anembodiment, the electromagnetic energy source generates an opticalsignal, such as laser or other electromagnetic energy, for example,visible light. In an embodiment, the electromagnetic energy detectorcaptures images. In an embodiment, the therapeutic composition sourcedelivers medicinal therapeutic. The at least one electrical signal,optical signal, image capture, or medicine may include one or moretherapies selected from the group consisting of anti-tumor,anti-seizure, anti-parkinson, anti-hydrocephalus, anti-ADHD,anti-alzheimer's, anti-pain, energy-enhancing, and combinations thereof.

Therefore, the physiological condition intervention system can include apower source and a sensor powered by the power source, wherein thesensor is configured to sense a physiological condition. In an example,the physiological condition intervention system comprises at least aportion of an imaging device, for example, an OCT system or optogeneticreceivers.

As described above, the device 300 may further include a controller (notshown), for example, a computer comprising a processor and a memory. Thecontroller may be included in the functional component or may bedisposed in another location of device 300. The at least one controllermay be configured to initiate or terminate dispensing of the medicinaltherapeutic 331 stored in the functional component Other on-boardhardware can include a wireless connectivity module so that thecontroller may be configured for wireless connectivity so as to beremotely monitored, activated or both. It is notable that each of thefunctional component may be in communication with at least one other ofa functional component via ports 327 (e.g. at least one electrode, fluidports, optic fibers, combinations thereof) and/or may be accessed, forexample, by way of a smart phone or hospital computerized system, forpurpose of charting timeline of neurological disease and response asexamples via communications links 325 disposed within the implant andwhich may couple with the ports 327 of the functional component.Similarly, a physician or caretaker could tap into the LID remotely tohelp obtain local information related to the underlying brain—such astumor recurrence, remote EEG (electroencephalogram) recordings, orseizure activity. Either way, the wireless (e.g., Wi-Fi) capabilitiesallow endless therapeutic options currently not available to patients orsurgeons.

The at least one functional component 322 may include a plurality offunctional components. Each of the plurality of functional components322 may be the same or different. For example, the functional componentcan include a first functional component and a second functionalcomponent, wherein the first functional component is the same ordifferent than the second functional component. For example, one or moreof the functional component may be a battery stimulation device,radioactive treatment device, a remote imaging device or a drug deliverydevice and one or more of other ones of a functional component may be amonitoring device or responsive electrostimulation device.

As illustrated in FIG. 3B-3C, the functional component 322 may be aplurality of functional components that share a uniform shape and may bephysically, electrically or communicatively (e.g., via a computernetwork) coupled to one another, such as clustered together as aninterconnected multi-cell functional component 322′. In an example, theplurality of functional components are electrically coupled to oneanother. The implant, including the functional component thereof, may bemade of a permeable material capable of accepting minimally-invasivebattery changes (e.g., a local slot for battery exchange below scalpwith small incision) or subcutaneous delivery of medicines via injectioninto a port within the LID, for example, using a syringe 337 to deliverthrough a surface 335 of the functional component 322 as shown in FIG.3B. In an embodiment, therefore, the functional component 322 comprisesat least one porous surface through which material, such as medicine,may be delivered, for example, via a syringe needle penetrating into astorage volume of the functional component or a local slot forminimally-invasive component exchange.

The functional component 322 of the embodiments may be provided invarious shapes. In an embodiment, each one of the functional components322 is the same shape. In another embodiment, one functional componentmay be the same or different shape as another component. In oneembodiment, one or more of the functional component may be a uniformshape. By using a uniform shape for the functional component 322, forexample, a polyhex, for the functional component 322 of device 300 ofthe embodiments, collaboration with multiple vendors is morepredictable. By creating, defining, and standardization this newapproach to treatment, multi-functions are expected for each implant andthey may be provided in a multi-piece configuration. A hexagon,triangle, or square for example all allow interlacing shapes toefficiently occupy a larger space. The functional component 322 may beconfigured so as to not have deleterious effects on the strength andintegrity of the implant. Rather, the functional component 322 may beconfigured to maximize the potential space within an implant while atthe same time, maximizing the structural integrity of the implant. Theseembodiments then may be defined as one of, or a combination of,interlocking hexagonal shapes working together or independently. Forexample, a hexagon with 1 cubic centimeter volume may be the standardunit of measure to build on. As shown in FIG. 3C, a device 300 mayinclude a 7-cell cluster of functional components 322 (i.e., amulti-cell functional component 322′). In such a cluster, one or more ofthe functional components may store medicine (Rx), batteries, or sensingdevices. However, it is noted that the embodiments are not limited toclusters of 7-functional components and may be adjusted accordingly toaccommodate larger devices as needed.

In addition to the features described above, device 300 may include abutton or manual switch on the implant surface to open a battery orcomponent replacement slot which allows for minimally invasive componentupdates/replacements (e.g., battery change) to the implant rather thanfull removal/replacement. For example, a button or manual switch may belocated on a side of the implant that is accessible via a smallminimally-invasive scalp incision. The button or pop-open slot canprovide access to the core of the LID, or could include a self-sealingport for which a special needle, such as a Huber needle, could be usedfor two-way access (delivery of neurologic medicine into brain tissue orbrain blood vessels or even blood draw or CSF removal from out of thebrain).

A method of an embodiment may include attaching the LID to a preselectedanatomical feature of interest, such as to a patients anatomysurrounding pathological or oncological defect sites directly overpreviously-resected epilepsy or brain tumor areas, such as in the caseof benign (i.e. meningioma) or malignant (i.e. glioblastoma) brainneoplasms, and/or within large cranial defects lying directly overprevious regions of stroke, trauma, aneurysmal bleeding, and/or boneflap osteomyelitic infection. For example, the LID may be attached to aportion of a being's craniomaxillofacial skeleton with rigid fixationplates/screws and/or biocompatible glue. As such, each of these previousillnesses may benefit from local electrode stimulation or drug deliveryspecific to the original pathology—such as blood thinners for someonewho had a thrombotic stroke or stem cell delivery for someone withrecent trauma. At least some embodiments described herein can be usedfor the immediate surgical repair of cranial defects and/or to removenormal skull just so that the local electrical or medicine deliveryoption can be available if needed. For example, embodiments describedherein may be used for designing, forming, modifying and/or implantingfunctional customized craniofacial implants (i.e., LIDs) followingbenign/malignant brain or skull neoplasm (tumor) resection (i.e., hereinreferred to as “single-stage implant cranioplasty”). As shown in FIG.4A, a skull opening during such procedures will expose the underlyingdura and brain. Thus, an implant so attached to the skull can bedisposed in direct, overlying proximity to the brain as shown in FIG.4B.

As shown in FIG. 4A, the device 300 may be inserted or replaced at aresected portion 201 of a skull during a surgical procedure, such as asurgical implantation procedure for various forms of craniomaxillofacialsurgery and/or neurosurgery including an implant-based cranioplasty. Thefunctional, custom skull implant of the embodiments may be configuredfor real-time delivery of responsive electricity, OCT imaging, ICPmonitoring, EEG tracing, radiation therapy, and/or pathology-specificmedicines that have not previously been deliverable or effective throughthe blood-brain barrier in order to treat either paraplegic (unilateralextremity weakness) or Alzheimer's disease (for enhanced memoryfunction), Parkinsonian patients (e.g., delivery of medicines for tremorcontrol), brain tumor patients (delivery of anti-tumor medicines and/orlocal radiation), epilepsy patients (anti-seizure medicines for bothcontrol and emergency rescue), hydrocephalus patients (e.g., to reduceintra-cranial pressures for both control and emergency situations),and/or deep cranial infection patients (antibiotic and antifungalmedicines).

As shown in FIG. 4B, the device 300 can be provided with communicationscapability so as to communicate (as indicated by double-headeddashed-line 500) with a computer 503, via for example, a server 501.While not limited to any particular embodiment, such communication maybe via electrical communication (such as via a USB cable) or viaelectromagnetic communication via Wi-Fi, Bluetooth, or the like. In oneexample, computer 503 may include a processor that executes softwareinstructions for communicating with the functional component 322 ofdevice 300. As such, remote monitoring of brain activity and/or tumorrecurrence could drastically reduce healthcare costs associated withhospital-based imaging such as MRI and could remove the need to have IVsplaced for contrast administration—since the necessary dye could bedelivered by the LID and imaging could also be done remotely by the LIDsimultaneously. While not limited to any particular embodiment, computer503 may be a desktop computer, notebook computer, smart phone, tablet, avirtual reality device, a mixed reality device and server 501 may be acloud server, Computer 503 may communicate with the device 300, forexample, functional components 322 of the implant, via the internet. Thefunctional component 322 may be activated remotely, for example, viasignals generated in computer 503. One example is analogous to a 24-hourcardiac heart monitor for which records heart activities for a certaintime period. With the LID of the embodiments, the implant device couldbe designed to monitor electrical activity, supranormal intracranialpressures, acute stroke-like bleeding, brain tumor recurrence, oraberrant seizure activity for a certain timeframe, and then at any time,the intervening physician, could download a recorded database of allactivities related to specific intervention (i.e. subclinical seizureactivity). Computer 503 may display data associated with signalsgenerated by the functional component 322 as it monitors a patients onwhom the device 300 is attached.

As described herein, provided is a low-profile intercranial device(LID). A LID of the embodiments can solve a multitude of existingcomplications resulting in a major reduction in neurological patientvisits and re-admissions (e.g., as related to brain pathologyexacerbations) to doctor's offices/hospitals as the implant isconfigured to perform brain imaging scans, deliver local headirradiation for brain tumor recurrence prevention, deliver medicines inreal-time to the central nervous system, and/or provide biometricfeedback testing in terms of vital signs—thereby saving the UShealthcare system billions of dollars each year related to periodictesting, imaging, neurological interventions, and/or unnecessaryhospitalizations. Accordingly, embodiments described herein may providethe potential to eradicate the need for labor-intensiveelectroencephalograms (EEGs) and spinal taps by providing a self-sealingvalve in subcutaneous tissue plane (comparable to a “portacath” usedcommonly for cancer patients requiring frequent intravenous drugadministrations) within the LID which will be attached directly underthe scalp with easy access. One advantage of the LIDs of the embodimentsis that they are fabricated for each patient-specific scenario—so thateach functionality is selected preemptively and individually customizedfor all patients depending on their pathology-specific scenario.Furthermore, the LIDs of the embodiment can also simultaneously correctcranial or craniofacial deformities by filling skeletal defects createdby neurosurgery or craniofacial plastic surgery. Therefore, the LIDsdescribed herein could be placed within a pre-existing skull or facialskeletal defect or could be placed in areas of normal bone, independentof knowing that a neurosurgical patient will need the additive benefitsof the LID of the embodiments.

In an example, the dispensing tube of the embodiments may be anintra-ventricular or intravenous catheter (IVC). For example, in anembodiment there is an LID that comprises an IVC. A lumen portion of theIVC has direct communication to the medicine(s)—so that a patient inwhich the LID is implanted could have pre-scheduled dosing of quantityand time intervals controlled by either an inside computer (a computerportion of the implant preprogrammed with dosage information) or outsidesignaling (e.g., Wi-Fi, communication via smartphone).

Other embodiments of the invention will be apparent to those skilled inthe art from consideration of the specification and practice of theinvention disclosed herein. It is intended that the specification andexamples be considered as exemplary only, with a true scope and spiritof the invention being indicated by the following claims.

In at least one embodiment, an LID is configured to provide for wirelessICP monitoring. In an example, wireless ICP monitoring provides patientswith a comfortable option for remote sensing of abnormal elevatedintra-cranial pressures, as similar to either cases of acute intensivecare unit (ICU) stays (typically less than 30 days) withinperi-operative period, or in instances of long-term pressure monitoringfor chronic conditions such as obstructive hydrocephalus, for instance.Such an LID having wireless ICP monitoring capabilities prevents theneed for hospital admission and direct connection to a machine devicefor sensor testing.

In at least one embodiment, an LID is configured to provide endocranialimaging by way of, for example, OCT, for imaging underlying brain tumorsor brain tumor resection cavities following surgery. Such functionalityprovides a way to, for example, remotely monitor new growths within thebrain following resection of disease. In one example of a system forproviding endocranial imaging, the functional component may comprise aCPU, ICP, or battery, and a component configured to monitor vitalsand/or cerebral blood flow to the region.

In at least one embodiment, an LID is configured to provide embedded“lead” stimulation. For example, at least one functional component maycomprise features similar to the RNS® System (available from Neuropaceof Mountain View, Calif.), for example, a cranially implantableprogrammable RNS® Neurostimulator that senses and records brainelectrical activity. As such, an LID of the embodiments may beconfigured to detect previously identified electrical patterns in thebrain and to deliver electrical stimulation to the brain to interruptsuch patterns before the patient experiences clinical seizures. In anexample, such an LID may comprise a functional component that includes aresponsive Neurostimulator and one or two leads that connect to theNeurostimulator.

In at least one embodiment, an LID may include local radiation therapyoptions for brain tumor patients for high risk of local recurrence. Thisadvancement, by incorporating radioactive seeds within the LID,functions to eradicate all risks for scalp-related complications such asdermatitis and/or exposed cranial hardware related to the standardexternal beam radioactive therapy modalities often used today. In suchan embodiment, an LID is a radioactive therapy device placed below thescalp for treatment of brain tumor pathology using a radio-lucentencasement floor (i.e. bottom part of LID such as a bottom base portion)and a radio-opaque ceiling (i.e. top part of LID such as an upper baseportion).

The terms “coupled,” “connected,” and “connecting” refer to “in directconnection with” or “in connection with via one or more intermediateelements or members.” Furthermore, to the extent that the terms“including”, “includes”, “having”, “has”, “with”, or variants thereofare used in either the detailed description and the claims, such termsare intended to be inclusive in a manner similar to the term“comprising.” As used herein, the phrase “at least one of” or “one ormore of”, for example, A, B, and C means any of the following: either A,B, or C alone; or combinations of two, such as A and B, B and C, and Aand C; or combinations of three A, B and C.

What is claimed is:
 1. A functional, low-profile intercranial device(LID), comprising: a base portion comprising a cranial or craniofacialimplant having a geometry that substantially conforms with a resectedportion of a skull of a patient, the cranial or craniofacial implantcomprising a polymer, metal, bioengineered material, or combinationsthereof, the cranial or craniofacial implant being shaped anddimensioned to correct deformities and/or defects by placement withinthe resected portion of the skull during a surgical procedure in such amanner that the cranial or craniofacial implant fills the resectedportion; at least one cavity associated with the base portion andconfigured to accept at least one functional component for delivering amedicinal therapeutic; and at least one conduit comprising a first endin communication with the cavity and configured to accept the medicinaltherapeutic and a second end configured to dispense the medicinaltherapeutic.
 2. The functional, low-profile intercranial device of claim1, wherein the functional component is a pump.
 3. The functional,low-profile intercranial device of claim 1, further including amedicinal therapeutic comprising one or more therapies selected from thegroup consisting of anti-tumor, anti-seizure, anti-parkinson,anti-hydrocephalus, anti-ADHD, anti-alzheimer's, anti-pain,energy-enhancing, and combinations thereof.
 4. The functional,low-profile intercranial device of claim 1, wherein the conduit deliversa medicinal therapeutic to a diseased portion of brain parenchyma, adead-space cavity following brain tumor resection, or a blood vessel,neuron or ventricle.
 5. The functional, low-profile intercranial deviceof claim 1, wherein the conduit comprises a catheter.
 6. The functional,low-profile intercranial device of claim 1, wherein the functionalcomponent is detachably connected to the base portion.
 7. Thefunctional, low-profile intercranial device of claim 6, wherein the baseportion comprises at least one porous surface through which a syringeneedle can penetrate.
 8. The functional, low-profile intercranial deviceof claim 6, wherein the base portion comprises at least one access portfor accepting a syringe needle.
 9. The functional, low-profileintercranial device of claim 1, wherein at least a portion of thefunctional component is encased in the base portion.
 10. The functional,low-profile intercranial device of claim 1, wherein the conduit extendsbetween the cavity and a diseased portion of brain parenchyma, adead-space cavity following brain tumor resection, a blood vessel, aneuron or a ventricle.
 11. The functional, low-profile intercranialdevice of claim 1, wherein the base portion comprises internal supportsextending through an internal portion thereof.
 12. The functional,low-profile intercranial device of claim 1, wherein cranial orcraniofacial implant is a custom cranial or craniofacial implant.
 13. Afunctional, low-profile intercranial device (LID), comprising: a baseportion comprising a cranial or craniofacial implant having a geometrythat substantially conforms with a resected portion of a skull of apatient, the cranial or craniofacial implant comprising a polymer,metal, bioengineered material, or combinations thereof, the cranial orcraniofacial implant being shaped and dimensioned to correct deformitiesand/or defects by placement within the resected portion of the skullduring a surgical procedure in such a manner that the cranial orcraniofacial implant fills the resected portion; and at least one cavityassociated with the base portion and configured to accept at least onefunctional component, wherein the functional component is pump.
 14. Thefunctional, low-profile intercranial device of claim 13, wherein thepump delivers a medicinal therapeutic.
 15. The functional, low-profileintercranial device of claim 14, wherein the cranial or craniofacialimplant includes at least one conduit comprising a first end incommunication with the cavity and configured to accept the medicinaltherapeutic and a second end configured to dispense the medicinaltherapeutic.
 16. The functional, low-profile intercranial device ofclaim 13, further including a medicinal therapeutic comprising one ormore therapies selected from the group consisting of anti-tumor,anti-seizure, anti-parkinson, anti-hydrocephalus, anti-ADHD,anti-alzheimer's, anti-pain, energy-enhancing, and combinations thereof.17. The functional, low-profile intercranial device of claim 16, whereinthe cranial or craniofacial implant includes at least one conduitcomprising a first end in communication with the cavity and configuredto accept the medicinal therapeutic and a second end configured todispense the medicinal therapeutic.
 18. The functional, low-profileintercranial device of claim 13, wherein the functional component isdetachably connected to the base portion.
 19. The functional,low-profile intercranial device of claim 13, wherein the base portioncomprises at least one access port for accepting a syringe needle. 20.The functional, low-profile intercranial device of claim 13, wherein atleast a portion of the pump is encased in the base portion.
 21. Thefunctional, low-profile intercranial device of claim 13, wherein thebase portion comprises internal supports extending through an internalportion thereof.
 22. The functional, low-profile intercranial device ofclaim 13, wherein cranial or craniofacial implant is a custom cranial orcraniofacial implant.